Murat Samli

Extracorporeal shockwave lithotripsy for solitary distal ureteral stones: Does the degree of urinary obstruction affect success?

BACKGROUND AND PURPOSE Extracorporeal shockwave lithotripsy (SWL) is a safe and effective way to treat stones in the distal ureter, but the impact of urinary obstruction on outcome is not clear. We investigated the relation between the degree of stone-induced urinary obstruction and the outcome of SWL treatment in patients with solitary distal ureteral stones. PATIENTS AND METHODS A series of 165 consecutive patients with solitary distal ureteral stones underwent SWL (Multimed 9200 Lithotriptor, Elmed Medical Systems, Turkey) between October 2002 and September 2003 at two separate centers. Distal ureteral stones were defined as those located below the lower border of the sacroiliac joint. Patients were divided into four groups according to the degree of stone-induced urinary obstruction: group I (N = 62) had no urinary system dilation; group II (N = 40) had mild dilation, group III (N = 35) moderate dilation, and group IV (N = 28) severe dilation. In addition to degree of obstruction, stone size, average fluoroscopy time, total number of shockwaves applied, number of sessions required to achieve stone-free status, and stone clearance time were recorded. Treatment failure was defined as persistence of fragments after three SWL sessions. RESULTS Overall, 152 (92.1%) of the patients became stone free after SWL. There were no statistically significant differences among the groups with respect to any of the factors studied. CONCLUSION In cases where there is a solitary calculus in the distal ureter, the degree of urinary obstruction caused by the stone does not affect the success of stone clearance with SWL.

Comparison of changes in tissue oxidative-stress markers in experimental model of open, laparoscopic, and retroperitoneoscopic donor nephrectomy

PURPOSE We evaluated the oxidative stress in renal tissue during three types of surgery: open donor nephrectomy (ODN), laparoscopic donor nephrectomy (LDN), and retroperitoneoscopic donor nephrectomy (RDN). The aim was to find out which is the appropriate procedure for harvesting a donor kidney. MATERIALS AND METHODS Twenty-four New Zealand White rabbits were randomized to four groups, each consisting of six rabbits. Group I (control) was subjected to 180 minutes of anesthesia, and transperitoneal nephrectomy was performed without creation of warm ischemia. In group II (ODN), after 180 minutes of anesthesia, warm ischemia was created for 5 minutes, and nephrectomy was performed. Group III (LDN) was subjected to 5 minutes of warm ischemia after 180 minutes of pneumoperitoneum at 12 mm Hg, and the kidney was removed. In group IV (RDN), after pneumoretroperitoneum at 12 mm Hg for 180 minutes, warm ischemia was created for 5 minutes, and nephrectomy was performed. Renal tissues were analyzed to determine malondialdehyde (MDA) and reduced glutathione (GSH) as oxidative-stress markers. RESULTS Renal tissue GSH levels were decreased, whereas MDA levels were increased in groups II through IV compared with the control group (p<0.05). There was no statistically significant difference between the ODN, LDN, and RDN groups in the renal oxidative-stress markers. CONCLUSION No differences were detected in oxidative-stress markers in renal tissue samples between ODN, LDN, and RDN. Therefore, we believe LDN and RDN can be used for live donor kidney harvesting as effectively as ODN without creating greater oxidative stress, which can have deleterious effects on a donor kidney.

Early effects of extracorporeal shock‐wave lithotripsy exposure on testicular sperm morphology

Objective: To investigate the effects of extracorporeal shock‐wave lithotripsy (ESWL) applied to the pelvic region on testicular histology and spermatogenesis. Material and Methods: ESWL (2000 shock waves over a 20‐min period at 18 kV) was applied to 12 adult New Zealand male rabbits. The rabbits were divided into three equal groups: those in Group 1 were sacrificed 1 h after the intervention, those in Group 2 were sacrificed on the 3rd day and those in Group 3 were sacrificed on the 7th day. Both testicles were removed for histopathological examination to investigate the effects of ESWL. Transmission electron microscopy (TEM) was used to detect ultrastructural changes. Epididymal and testicular touch‐print preparations were stained with SperMac ® stain in order to evaluate the morphology of the spermatozoa. Results: There were no significant differences between the groups in terms of sperm morphology (p = 0.386). TEM revealed only huge vacuolation of Sertoli cells and diffuse edema in the mitochondria of Sertoli cells. Conclusion: No detrimental effect of ESWL on sperm morphology was detected in this study. We conclude that shock waves do not cause severe permanent effects but only transient disorders in testes.

The effect of carbon dioxide pneumoretroperitoneum on free oxygen radicals in rabbit retroperitoneoscopy model.

The aim of this study was to investigate the possible effects of carbon dioxide (CO2) pneumoretroperitoneum on free oxygen radicals in the kidney. Twelve male New Zealand rabbits were divided into 2 equal groups; group 1; control operation group (retroperitoneal space preparation without CO2 insufflation) and group 2; study group (10–12 mm Hg pneumoretroperitoneum for 3 hours with CO2). At the end of the procedure, laparotomy was performed to harvest ipsilateral and contralateral kidney in both groups after three hours. Kidney tissues were homogenized and were assayed for malondialdehyde (MDA), protein carbonyls (for protein oxidation), and reduced glutathione (GSH). Ipsilateral and contralateral kidney tissue levels of the MDA, protein carbonyls and GSH were not different in both the study and the control group (P > 0.05 for all comparisions). Corresponding ipsilateral and contralateral tissue levels of the markers, MDA and protein carbonyls were found to be significantly different in the study group as compared with the control group (P < 0.05 for the four comparisons mentioned). However, neither the ipsilateral nor the contralateral tissue levels of the marker GSH showed statistically relevant difference when the study group was compared with the control group. Oxidative stress was identified as a component of CO2 pneumoretroperitoneum-induced kidney injury using an animal model of retroperitoneoscopy. Oxidative stress is likely to contribute to the impairment of renal function after retroperitoneoscopy using a 10 mm–12 mm Hg CO2 pneumoretroperitoneum.